Irrigation solutions used in the chemical-mechanical preparation of the root canals system: a literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v10i13.21453

Keywords:

Chlorhexidine; Sodium hypochlorite; Root Canal Preparation; EDTA; Endodontics.

Abstract

The present work aims to review the literature identifying the importance of chemical compounds used in the biomechanical preparation of the root canal system, comparing the compounds most used in clinical practice to carry out the operative stage of irrigation. A bibliographic survey was carried out in the databases of PubMed, Scielo, Lilacs, Science Direct and book queries in the physical library of a private college, including studies that addressed irrigation in the treatment of root canal systems, with a delimited period of specific time between 2013 to 2021, excluding those with no direct relation to the subject. Following the inclusion criteria, the available abstracts were read and 20 articles were identified, which were part of this study. Given the above, each irrigating substance studied has its advantages and disadvantages, with Sodium Hypochlorite (NaOCl) being the most used irrigant for demonstrating antimicrobial action and the ability to dissolve organic tissue, providing success in the treatment of SCR, however, in high concentrations may present cytotoxicity to pulp and periradicular tissues. Thus, the knowledge of professionals about these solutions in their use is of fundamental importance, in order to understand the results that will be achieved in the operative stage of irrigation.

References

Agrawal, V. S., Mahant, R., Kapoor, S., & Patel, M. (2014). A contemporary overview of endodontic irrigants–A review. Journal Dental Applications, 1 (6), 105-115. https://www.researchgate.net/profile/Rajesh-Mahant/publication/277721660_A_Contemporary_Overview_of_Endodontic_Irrigants_-_A_Review/li nks/5572810608aeb6d8c0175fff/A-Contemporary-Overview-of-Endodontic-Irrigants-A-Review.pdf

Alegre, O., Yévenes, I., Parada, J., Maggiolo, S., & Fernández, E. (2017). Determination of residual parachloaniline produced by endodontic treatment after the use of 5% sodium hypochlorite and 2% chlorhexidine combined: na ex-vivo study. Rev. Clín. Periodoncia implantol. Rehabil. Oral, 10(3) 145-148. https://pesquisa.bvsalud.org/portal/resource/pt/biblio-900296

Baldasso, F. E. R., Roleto, L., Silva, V. D., Morgental, R. D., & Kopper, P. M. P. (2017). Effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin. Brazilian Oral Research, 31(1). https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242017000100237&lng=en&nrm=iso&tlng=en

Beraldo, Â. J. S., Silva, R. V., & Nunes, E. (2017). Scanning electron microscopic evaluation of smear layer removal using isolated or interweaving EDTA with sodium hypochlorite. Iranian endodontic journal, 12(1), 55-59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282380/

Bottcher, D. E., Sehnem, N. T., Montagner, F., Parolo, C. C. F., & Grecca, F. S. (2015) Evaluation of the effect of Enterococcus faecalis biofilm on the 2% chlorhexidine substantivity: an in vitro study. Journal of endodontics, 41(8), 1364-1370. https://www.sciencedirect.com/science/article/abs/pii/S0099239915003854

Bukhary, S., & Balto, H. (2017). Eficácia antibacteriana de octenisept, alexidina, clorexidina e hipoclorito de sódio contra biofilmes de Enterococcus faecalis. Journal of Endodontics, 43(4), 643-647. https://www.sciencedirect.com/science/article/abs/pii/S0099239916306173

Chubb, D. W. R. A. (2019). Review of the prognostic value of irrigation on root canal treatment success. Australian Endodontic Journal, 45(1), 5-11. https://onlinelibrary.wiley.com/doi/abs/10.1111/aej.12348

Cortes, H. M., Uribe, M. T. M., Arriagada, F. A., & Reveco, J. A. (2019) Capacidad de Disolución del Hipoclorito de Sodio con o sin Activación. Avances en Odontoestomatologia, 35(3), 113-118. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852019000300003&lng=es&nrm=iso

Darcey, J., Jawad, S., Taylor, C., Roudsari, R. V., & Hunter, M. (2017). Modern endodontic principles part 4: irrigation. Atualização dental, 43(1), 20-33. https://www.magonlinelibrary.com/doi/abs/10.12968/denu.2016.43.1.20

Darda, S., Madria, K., Jamenis, R., Heda, A., Khanna, A., & Sardar, L. (2014). An in-vitro evaluation of effect of EDTAC on root dentin with respect to time. Journal of International Oral Health, 6(2), 22-27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037788/

Dewi A., Upara, C., Chaiariyakul, D., & Louwakul, P. (2020). Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine. European Endodontic Journal, 5(3), 257-263. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881384/

Dhawan R., Gupta, A., Dhillon, J. S., Dhawan, S., Sharma, T., & Batra, D. (2019). Effect of different irrigating solutions with surfactants on the microhardness and smear layer removal of root canal dentin: An in vitro study. J Conserv Dent. 22(5), 454-458. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537743/

Dioguardi, M., Gioia, G. D., Illuzzi, G., Laneve, E., Cocco, A., & Troiano, G. (2018). Endodontic irrigants: Different methods to improve efficacy and related problems. European Journal of Dentistry, 12(3), 459-466. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089055/

Echeverri, D. & Alderete, D. (2015). In vitro Antibacterial Effect of 2% Chlorhexidine Against Enterococcus faecalis in Dentin Previously Irrigated with 5% Sodium Hypochlorite. Int. J. Odontostomat, 9(1), 25-29. https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-381X2015000100004&lng=es&nrm=iso

Gomes, B. P. F. A., Vianna, M. E., Zaia, A. A., Almeida, J. F., Souza, F. J. F., & Ferraz, C. C. (2013). Chlorhexidine in endodontics. Brazilian dental journal, 24(2), 89-102. https://pubmed.ncbi.nlm.nih.gov/23780357/

Gonçalves, L. S., Rodrigues, R. C. V., Andrade, C. V. Jr., Soares, R. G., & Vettore, M. V. (2016). The effect of sodium hypochlorite and chlorhexidine as irrigant solutions for root canal disinfection: a systematic review of clinical trials. Journal of endodontics, 42(4), 527-532. https://www.jendodon.com/article/S0099-2399(15)01151-6/fulltext

Guo, X., Miao, H., Li, L., Zhang, S., Zhou, D., Lu, Y., & Wu, L. (2014). Efficacy of four different irrigation techniques combined with 60 C 3% sodium hypochlorite and 17% EDTA in smear layer removal. BMC oral health, 14(1). https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-14-114

Haapasalo, M., Shen, Y., Wang, Z., & Gao, Y. (2019). Irrigation in endodontics. British dental journal, 216(6), 299-303. https://www.nature.com/articles/sj.bdj.2014.204.pdf

Iandolo, A., Dagna, A., & Abdellatif, D. (2019). Evaluation of the actual chlorine concentration and the required time for pulp dissolution using different sodium hypochlorite irrigating solutions. J Conserv Dent. 22(2), 108-113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519176/

Leonardo, M. R., & Tanomaru, J. M. G. (2017). Preparo biomecânico dos canais radiculares: definição, conceituação, importância, finalidades e recursos convencionais para sua aplicação. In: M. Leonardo, R & R. Leonardo, T. Tratamento de canais radiculares (2a ed.), Cap. 4, pp. 25-37. Artes Médicas.

Lopes, H. P., & Siqueira, J. F., Jr. (2013) Substâncias químicas empregadas no preparo dos canais radiculares. In: H. Lopes, P., & J. Siqueira, F., Jr. Endodontia: biologia e técnica (3a ed.), Cap. 14, pp. 478-496. Guanabara KOOGAN.

Luz, L. B., Santana, R. M. C., Prates, A. W., Frorhlich, J., Melo, T. A. F., Montagner, F., & Luisi, S. B. (2019). Evaluation of smear layer formation in mechanical chemical preparation performed with 2.5% sodium hypochloride solution or gel. Journal of Health & Biological Sciences, 7(2), 159-165. https://periodicos.unichristus.edu.br/jhbs/article/view/2328

Ma, J., Tong, Z., Ling, J., Liu, H., & Wei, X. (2015). The effects of sodium hypochlorite and chlorhexidine irrigants on the antibacterial activities of alkaline media against Enterococcus faecalis. Archives of Oral Biology, 60, 1075-1081. https://www.sciencedirect.com/science/article/abs/pii/S0003996915000977

Mafra, S. C., Girelli, C. F. M., Xavier, V. F., Lacerda, M. F. L., Lacerda, G. P., & Coelho, R. G. (2017). The effectiveness of EDTA solution in removing smear layer and its relationto the time of use: an integrative review. Revista da Faculdade de Odontologia-UPF, 22(1), 120-129. http://seer.upf.br/index.php/rfo/article/view/6305

Marinho, A. C. S., Martinho, F. C., Zaia, A. A., & Ferraz, C. C. R. (2014). Monitoring the effectiveness of root canal procedures on endotoxin levels found in teeth with chronic apical periodontitis. Journal of applied oral science, 22(6), 490-495. https://www.scielo.br/scielo.php?pid=S1678-77572014000600490&script=sci_arttext

Marion, J., Pavan, K., Arruda, M. E. B. F., Nakashima, L., & Morais, C. A. H. (2013). Chlorhexidine and its applications in Endodontics: a literature review. Dental Press Endod, 3(3). https://www.researchgate.net/profile/Jefferson-Marion/publication/287337747_Chlorhexidine_and_its_applicatio ns_in_ Endodontics_A_literature_review/links/56a76d4508ae0fd8b3fe024f/Chlorhexidine-and-its-applications-in-Endodontics-A-literature-review.pdf

Mirhadi, H., Abbaszadegan, A., Ranjbar, M. A., Azar, M. R., Geramizadeh, B., Torabi, S., Aleyasin, Z. S., & Gholami, A. (2015). Efeito antibacteriano e tóxico do peróxido de hidrogênio combinado com diferentes concentrações de clorexidina em comparação com o hipoclorito de sódio. Journal of dentistry (Shiraz), 16 (4), 349-355. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664033/

Mohammadi, Z., Giardino, L., & Asgary, S. (2015). Agonistic and Antagonistic Interactions between Chlorhexidine and Other Endodontic Agents: A Critical Review. Iranian Endodontic Journal, 10(1), 1-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293573/

Neelakantan, P., Herrera, D. R., Pecorari, V. G. A., & Gomes, B. P. F. A. (2019). Endotoxin levels after chemomechanical preparation of root canals with sodium hypochlorite or chlorhexidine: a systematic review of clinical trials and meta-analysis. Int Endod J, 52 (1), 19-27. https://onlinelibrary.wiley.com/doi/full/10.1111/iej.12963

Nocca, G., Ahmed, H. M. A., Martorana, G. E., Callà, C., Gambarini, G., Rengo, S., & Spagnuolo, G. (2017). Chromographic Analysis and Cytotoxic Effects of Chlorhexidine and Sodium Hypochlorite Reaction Mixtures. Journal of endodontics, 43(9), 1545-1552. https://www.sciencedirect.com/science/article/abs/pii/S0099239917305319

Orlowski, N. B., Schimdt, T. F., Teixeira, C. S., Garcia, L. F. R., Savaris, J. M. Tay, F. R., & Bortoluzzi, E. A. (2020). Smear layer removal using passive ultrasonic irrigation and diferente concentrations of sodium hypochlorite. Journal of endodontics, 46 (11), 1738-1744. https://www.sciencedirect.com/science/article/abs/pii/S0099239920305094

Ozkan, H. B., Cobankara, F. K., & Ozer, F. (2020). Evaluation of the Antibacterial Effects of Single and Combined use of Different Irrigation Solutions Against Intracanal Enterococcus Faecalis. Acta Stomatol Croat. 54(3), 250-262. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586900/

Rahimi, S., Jananib, M., Lotfic, M., Shahia, S. Aghbalia, A., Pakdeld, M. V., Milania, A. S., & Ghasemib, N. (2014). A review of antibacterial agents in endodontic treatment. Iranian endodontic journal, 9 (3), 161-168. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099945/pdf/iej-9-161.pdf

Rajakumaran, A., Ramesh, H., Ashok, R., Balaji, L., & Ganesh A. (2019). Smear Layer Removal and Microhardness Alteration Potential of a Naturally Occurring Antioxidant - An In Vitro Study. Cureus, 25(11). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759042/pdf/cureus-0011-00000005241.pdf

Rôças, I. N., Provenzano, J. C., Neves, M. A. S., & Siqueira, J. F. Jr. (2016). Disinfecting effects of rotary instrumentation with either 2.5% sodium hypochlorite or 2% chlorhexidine as the main irrigant: a randomized clinical study. Journal of endodontics, 42(6), 943-947. https://www.sciencedirect.com/science/article/abs/pii/S009923991630108X

Rother, E. T. (2007). Revisão sistemática X revisão narrativa. Acta paul. Enferm. 20 (2), 5-6. https://www.scielo.br/j/ape/a/z7zZ4Z4 GwYV6FR7S9FHTByr/?lang=pt

Ruksakiet, K., Hanák, N., Farkas, N., Hegyi, P., Sadaeng, W., Czumbel, L. M., Sang-Ngoen, T., Garami, A., Mikó, A., Varga, G., & Lohinai, Z. (2020). Antimicrobial efficacy of chlorhexidine and sodium hypochlorite in root canal disinfection: a systematic review and meta-analysis of randomized controlled trials. Journal of endodontics, 46 (8), 1032-1041. https://www.sciencedirect.com/science/article/pii/S0099239920303083

Sarmento, E. B., Guimaraes, L. S., & Gomes, C. C. (2020). The Influence of Sodium Hypochlorite and Chlorhexidine on Postoperative Pain in Necrotic Teeth: A Systematic Review. European Endodontic Journal, 5(3), 177-185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881388/

Seelan, R. G., Kumar, A., Jonathan, R., Maheswari, U., Raja, J., & Chelliah, P. (2015). Comparative evaluation of effect of different irrigation solutions against Enterococcus faecalis: A polymerase chain reaction-based study. Journal of pharmacy & bioallied sciences, 7(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606663/

Serrano, N. D. M. (2018). Influência de la activación ultrasónica del hipoclorito de sodio y de la clorhexidina sobre el biofilm: Estudio ex vivo. Rev Cient Odontol, 6(2), 129-142. https://revistas.cientifica.edu.pe/index.php/odontologica/article/view/465/527

Silva, E. J. N L., Monteiro, M. R., Belladona, F. G., Almeida, J. F., De-Deus, G., & Neves, A. A. (2015). Postoperative pain after foraminal instrumentation with a reciprocating system and different irrigating solutions. Brazilian dental journal, 26 (3). https://www.scielo.br/scielo.php?pid=S0103-64402015000300216&script=sci_arttext

Silva, F., Francisco, N. L. S. G., Brum, S. C., Barbosa, C. C. N., & Soares, L. C. (2016). Antimicrobial activity irrigating solutions to prepare channels biomechanical root face to Enterococcus Faecalis. Brazilian Journal of Surgery and Clinical Research, 15(1), 34-38. https://www.mastereditora.com.br/periodico/20160612_102251.pdf

Silveira, C. M. M., Pimpão, M. V., Fernandes, L. A., Westphalen, V., Cavenago, B.C., & Carneiro, E. (2019). Influence of Different Irrigation Solutions and Instrumentation Techniques on the Amount of Apically Extruded Debris. European endodontic journal, 4 (3), 122-126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006593/

Siqueira, A. L., Dantas, C. G., Gomes, M. Z., Padilha, F. F., Albuquerque, R. L. C. D., & Cardoso, J. C. (2014). Study of antibacterial action of hydroalcoholic extract of propolis red on Enterococcus faecalis. Revista de Odontologia da UNESP, 43(6), 359-366. https://www.scielo.br/scielo.php?pid=S1807-25772014000600359&script=sci_arttext

Souza, F. J. F. (2015). Endodontia passo a passo: Evidências clínicas. In: B. Gomes, P. F. A. Microbiologia Aplicada. Cap. 2, pp. 26-30. Artes Médicas.

Ulusoy, O. I., Savur, I. G., Alaçam, T., & Çelik, B. (2018). The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects. International endodontic Journal, 51(1), 1030-1036. https://onlinelibrary.wiley.com/doi/abs/10.1111/iej.12919

Yadav, H. K., Yadav, R. K., Chandra, A., & Tikku, A. P. (2017). A Scanning Electron Microscopic Evaluation of the Effectiveness of Etidronic Acid, SmearClear and MTAD in Removing the Intracanal Smear Layer. Journal of Dentistry, 18(2), 118-126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457522/

Zandi, H., Rodrigues, R. C. V., Kristoffersen, A. K., Ørstavik, D., Roças, I. N., & Siqueira, J. F. Jr. (2016). Antibacterial effectiveness of 2 roots canal irrigants in root-filled teeth with infection: a randomized clinical trial. Journal of endodontics, 42(9), 1307-1313. https://www.jendodon.com/article/S0099-2399(16)30341-7/fulltext

Published

17/10/2021

How to Cite

AGUIAR, Y. L. de; AMARAL , P. A. S.; PEREIRA, L. C. Irrigation solutions used in the chemical-mechanical preparation of the root canals system: a literature review. Research, Society and Development, [S. l.], v. 10, n. 13, p. e399101321453, 2021. DOI: 10.33448/rsd-v10i13.21453. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/21453. Acesso em: 8 dec. 2021.

Issue

Section

Health Sciences